Andrea Bazan, M.D, S.C

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036-095548 Issued in IL

Legal business name

ANDREA BAZAN, M.D, S.C

Practice address

1600 West Dempster Street
Suite #120
Park Ridge, IL 60068

Phone

(847) 299-7888

Fax

(847) 299-7844

NPI assigned

Jul 10, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Andrea M. Bazan, M.D.

Title

President

Phone

(773) 575-0613

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348531200000",
    "number": "1437357795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 WEST 24TH PLACE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606162229",
            "telephone_number": "773-575-0613",
            "fax_number": "847-299-7844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 WEST DEMPSTER STREET",
            "address_2": "SUITE #120",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "60068",
            "telephone_number": "847-299-7888",
            "fax_number": "847-299-7844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREA BAZAN, M.D, S.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-10",
        "last_updated": "2012-09-25",
        "status": "A",
        "authorized_official_last_name": "BAZAN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-575-0613",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036095548",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-095548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036095548",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ethan Jerrick Anderson
• Jenna Anderson
• Martin Emil Anderson Jr., M.D.
• Patricia Jean Anderson, LCPC
• Nimfa Andrade
• Bernard P Andres, APN-CNP
• Kristy Rita Andrews, MD
• Lineya Ann Andrews
• Amanda Aimee Angelopoulos, LDN, RD
• Brad Angle, MD

• Internal Medicine Physician in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.